Optimizing Orthoptic Pathways in Surgical Management of Orbital Fractures

Abstract

Introduction: Gold standard management of orbital fractures requires a multidisciplinary approach (MDT) involving maxillofacial surgery, orthoptics, and ophthalmology. Orthoptic evaluations provide essential baseline assessments and identify functional deficits critical for pre- and postoperative decision-making. Without national guidelines for orthoptic assessment timing, this project aimed to create a consistent review protocol to improve patient care and follow-up reliability. Method(s): A two-cycle quality improvement project included 40 patients per cycle. Patients with surgically managed orbital fractures from June 2022 to February 2023 (cycle 1) were retrospectively reviewed, followed by the introduction of a protocol. The next 40 patients, from October 2023 to August 2024 (cycle 2), were prospectively analyzed. The protocol scheduled orthoptic reviews preoperatively and postoperatively at 1, 4-6, and 10 weeks, with symptom-led referrals to the strabismus team. Result(s): Implementation of the protocol in cycle 2 improved consistency in orthoptic assessments. Preoperative evaluations were conducted for 34/40 patients in cycle 2 compared to 25/40 in cycle 1. At week 1 post-op, 26/40 patients were seen in cycle 2 versus 15/40 in cycle 1. Only one patient with ongoing diplopia in cycle 2 missed review, compared to six in cycle 1. Referrals to the strabismus team increased from one in cycle 1 to five in cycle 2, underscoring the value of consistent orthoptic input for timely MDT referrals. Conclusion(s): The protocol supports a responsive, outcome-focused approach to orbital trauma care, ensuring standardized, symptom-specific patient management.Copyright © 2025